On-admission high endothelin-1 level independently predicts in-hospital adverse cardiac events following ST-elevation acute myocardial infarction

Abstract

IntroductionVarious cardiovascular diseases cause increased level of plasma endothelin-1. In acute myocardial infarction, necrotic cardiomyocites release endothelin-1 in the circulation, thus increasing the level of endothelin-1. AimThe purpose of this study is to investigate whether increased circulating endothelin-1 level predicts subsequent adverse cardiac events in patients hospitalized with ST-elevation acute myocardial infarction (STEMI). MethodsWe designed a cohort study and enrolled STEMI patients with symptom onset ≤24h. Consecutive subjects were enrolled and followed-up during intensive hospitalization. Endothelin-1 was measured from venous blood on admission before reperfusion procedure. Based on median value, subjects were divided into two groups, those with high endothelin-1 and low endothelin-1. In-hospital adverse cardiac events were death, acute heart failure, cardiogenic shock, reinfarction and rescuscitated VT/VF. Univariate and multivariable analyses were applied to evaluate the prediction value of high endothelin-1. ResultsWe enrolled 125 subjects. The incidence of in hospital adverse cardiac events is 29.6%. The proportion of adverse cardiac events was significantly higher in high endothelin-1 groups as compared with low endothelin-1 group (42.2% versus 16.4%, p=0.02). Univariate analysis indicated that high endothelin-1 predicted in hospital adverse cardiac events. Multivariable analysis determined that high endothelin-1 level was an independent predictor for in hospital adverse cardiac events (adjusted odds ratio: 3.4, 95% CI: 1.2–9.8, p=0.026). Other independent predictors were older age and faster heart rate on admission. ConclusionHigher level of circulating endothelin-1 on admission independently predicts subsequent in hospital major adverse cardiac events in patients presenting with STEMI.